Summary
It is well known that learning curves are longer for laparoscopic surgery compared to open surgery. Recently, virtual reality (VR) simulation was developed as alternative to conventional training. Such a new training system makes it possible to offer a wide range of repeatable surgical situations, and thus, enable assessments based on direct observation of performance. During the last four years we did several studies using a VR simulator (LapSim®). After a constructive validity study – discrimination between novices and experienced laparoscopic surgeons, we were able to show that advanced residents benefit most from a three-day practical course for laparoscopic surgery, while – in a further investigation – we found contrary to training at the Pelvitrainer that novices in laparoscopic surgery have the most benefit from VR training. Minimally invasive surgery is significantly more sophisticated for the surgeon than open surgery. While Research on laparoscopic surgery has focused primarily on the development and assessment of technical skills, non technical skills such as visual-spatial perception and stress coping has received much less attention. We showed that spatial perception as well as stress coping positively correlates with virtual laparoscopic skills. A high degree of spatial perception led to faster adaption to a non-stereo environment and correlated with high level of laparoscopic skills. Furthermore, Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. VR simulation seems to be a promising tool to improve laparoscopic skills in a modern apprenticeship model. According to patient safety, the development of this instrument for surgery should be advanced professionally just as a flight simulators in aviation.
Zusammenfassung
Bei laparoskopischen Operationen bestehen längere Lernkurven als bei konventionellen Operationen. In den letzten Jahren wurden als Alternative zum herkömmlichen Training, virtuelle Operations-Simulatoren entwickelt. Diese gestatten das Üben in einer computergenerierten Umgebung und erlauben das gezielte Training von technischen Fähigkeiten in frei wählbaren Szenarien. In den letzten vier Jahren wurde an der chirurgischen Universitätsklinik Marburg mit Hilfe des Laparoskopiesimulators (LapSim®) eine Reihe von Untersuchungen durchgeführt. Nach initialer Validierung des Simulators "Abbildung laparoskopischer Fertigkeiten von laparoskopisch erfahrenen und weniger erfahrenen Ärzten" konnte der Lernerfolg nach einem praktischen Laparoskopiekurs am Pelvitrainer gemessen und damit die Zielgruppe des Kurses ermittelt werden. In einem weiteren Untersuchungskomplex fanden wir im Gegensatz zu dem Training am Pelvitrainer, dass gerade die Anfänger den höchsten Lernerfolg am Simulator haben. Da die laparoskopischen Operationen besondere Anforderungen an den Chirurgen stellen, gewinnen neben der manuellen Geschicklichkeit auf hohem Niveau auch individuelle Faktoren wie z.B. räumliche Orientierung und Stressverarbeitungsstrategien also sogenannte "non-technical-skills" für die Eignung als laparoskopischer Chirurg zunehmend an Bedeutung. So konnte in weiteren Untersuchungen gezeigt werden, dass das räumliche Denken sowie eine gute Stressverarbeitung positiv mit virtuellen laparoskopischen Fähigkeiten korrelieren. Probanden mit hohem Maß an räumlichem Denkvermögen verfügen über bessere virtuelle laparoskopische Fertigkeit als die Probanden mit geringerem räumlichen Denkvermögen. Des weiteren haben Probanden, die inadäquate Stressbewältigungsstategien besitzen, komplexe Aufgaben am Simulator schlechter durchgeführt als Probanden mit adäquaten Stressbewältigungsstategien. Die virtuelle Laparoskopie ist ein viel versprechendes Werkzeug in der chirurgischen Weiterbildung. Im Interesse des Patienten sollte die Entwicklung dieses Instrumentes in der Chirurgie ebenso professionell vorangetrieben werden wie jene von Flugsimulatoren in der Luftfahrt.
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Hassan, I., Osei-Agymang, T., Radu, D. et al. Simulation endoskopischer Operationen – Vier Jahre Erfahrung an der Chirurgischen Universitätsklinik Marburg. Wien Klin Wochenschr 120, 70–76 (2008). https://doi.org/10.1007/s00508-008-0930-8
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DOI: https://doi.org/10.1007/s00508-008-0930-8